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World Health Systems Facts

Italy: Social Determinants and Health Equity


“In terms of morbidity, generally, in Italy people in lower-income groups tend to suffer from poor health more often and register lower life expectancy compared with other European countries. This inequality peaks among middle-aged individuals, when mortality is considered avoidable, and has been further accentuated with the COVID-19 pandemic (ONSRI, 2020). In terms of mortality, however, compared with other European countries, inequalities in Italy are less prominent, probably due to lifestyle factors such as the Mediterranean diet, the presence of family support networks and a universal health care system.”

Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.


“Amenable mortality (also called mortality from treatable causes) refers to deaths in people under 75 years old which should not occur if people have access to timely and effective health care interventions, including secondary prevention and treatment. Preventable mortality is broader and includes deaths in those under 75 which could have been avoided through public health interventions focusing on the wider determinants of public health, such as behaviour and lifestyle factors, socioeconomic status and environmental factors. Low and decreasing rates of preventable and amenable mortality reflect the effectiveness of Italy’s health system (see also ISTAT, 2020d) (Fig. 7.6).

“Since 2011, amenable mortality rates have been among the lowest in Europe, and in 2019, Italy had the sixth lowest rate among EU countries. In the Italian regions, the best performers are all located in the centre-north. In 70% of cases, amenable mortality rates have been linked to colon and rectal cancers (19.09%), cerebrovascular diseases (18.23%), ischaemic heart disease (17.06%), and breast cancer (16.66%) (ONSRI, 2020).16 In the past 30 years, death rates for cardiovascular diseases have decreased by more than half and for neoplasms by almost a third. However, in parallel, dementia and Alzheimer’s diseases are increasing along with chronic respiratory diseases, hypertension, influenza and pneumonia (Monasta et al., 2019). Behavioural risk factors and demographic changes seem to play an important role in these trends.

“Following reductions between 2011 and 2019 in ischaemic heart disease,17 lung cancer, accidental deaths, suicide and alcohol-related diseases, preventable mortality values also are all well below the EU average, given the lower prevalence of risk factors, effective treatments and lower incidence of these health conditions.”

Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.


“Heterogeneity in mortality rates is more accentuated for cardiovascular disease, respiratory diseases and accidents, whereas mortality rates due to cancer are more uniform. Inequalities due to social determinants are a constant for all regions, but are more marked in the poorer regions of the south. Specifically, for education level inequalities, there is a 3-year difference in life expectancy between men with high education and those with low education (ISTAT, 2018). Furthermore, the pandemic had a strong impact on the older population: the share of over 75-year-olds with severe limitations or with multi-chronic conditions (suffering from three or more chronic conditions) is 48.8%, with higher values in the south and in people with lower levels of education (ISTAT, 2020c). In general, geographical differences in mortality are relevant regardless of age and socioeconomic status. Moreover, the poorer southern regions generally record lower health status, while regions along the Adriatic coast are the healthiest. A lower education level explains a considerable proportion of mortality risk, although with different effects by geographical area and cause of death.

“These variations are also carried through into healthy life years (HLY) i.e. in 2020, the average life expectancy without health limitations and/or disability was 62.8 years, with important differences among regions. Specifically, Umbria has the highest value (67.5 years), followed by the autonomous provinces of Trento and Bolzano (66.9 and 66.5 years respectively). In contrast, Calabria in the south of the country presents the lowest value with 58.1 years (The European House – Ambrosetti, 2021).”

Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.


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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated January 8, 2025 by Doug McVay, Editor.

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